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Giving African American Babies a Healthier Start Genesee County Healthy Start Supported in part by project H49MC00148-05-00 from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau (Title V, Social Security Act).

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Giving African American

Babies a Healthier Start

Genesee CountyHealthy Start

Supported in part by project H49MC00148-05-00 from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau (Title V, Social Security Act).




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Flint, Michigan

  • 4th largest city (120,000)

  • Manufacturing base

  • General Motors; UAW

  • 35% population decrease

  • Poverty, unemployment, violence

  • Racial health disparities

  • Community activism


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Genesee County, Michigan

African American White

City of Flint: 55.8% 39.3%

County: 20.2% 75.4%

  • In the City of Flint…

  • 45% of children < 18 years live below poverty

  • 28% of all families live in poverty

  • 52% of female householder families live in poverty

Population: 436,141

Source: U.S. Census Bureau, American Community Survey Fact Sheet, 2004 and 2005


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OB Care in Genesee County

2,768 births/year

35% Medicaid births

811 births/year

8% Medicaid births

2,721 births/year

57% Medicaid births

Averages calculated using 1997-2005 live birth data


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Healthcare in Genesee County

  • 791 primary care physicians

  • 6 certified nurse midwives

  • 85 prenatal care providers at 49 sites

  • 3 perinatologists (2 high-risk clinics)

  • 1 NICU

  • 11 PNC provider offices located in IM zips


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In Genesee County….

6,282 births per year

(1998-2005 average)

On average 69 infants die

each year (2000-2006 Infant Deaths)

Of the 69 infant deaths,

34 are black infants

Black babies die 2-3 times more than other babies


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Number of Infant Deaths By RaceGenesee County, Michigan1999-2006 (2006 preliminary)

Source: Genesee County Health Department, 1999-2006 Fetal-Infant Mortality Statistics


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Annual Infant Mortality Rates by RaceGenesee County, MI 1999-2005

Source: Michigan Department of Community Health, Vital Records & Health Data Development Section.


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Infant Mortality Disparity Ratio*Genesee County, Michigan 1999-2005

*African American to White Disparity Ratios

Source: Michigan Department of Community Health, Vital Records & Health Data Development Section.


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Infant Cause of DeathGenesee County 2002-06(preliminary)

N=339


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Healthy Start

Supported in part by project H49MC00148-05-00 from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau (Title V, Social Security Act).


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Purpose

To reduce infant mortality, reduce perinatal depression, & improve neonatal outcomes among pregnant & post partum African American women and infants & children from birth to 2 years old.


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Genesee County, MIHealthy Start Logic Model

Partners

  • Conditions

  • (City of Flint)

  • AA IM rate is 21.3*

  • Low Birth Weight among AA is12.4%

  • Very Low Birth Weight among AA is 3.7%

  • *Per 1,000 live births

  • Interventions

  • Outreach

  • Case Mgmt

  • Screening/Assmt

  • Home visits

  • Support Groups

  • Health Education

  • Consortium

  • Target Population

  • Pregnant AA women

  • AA/Bi-racial children (birth to 2)

  • Zip codes 48503,48504, 48458

Expected Outcomes

>Access to PNC in 1st trimester

>Babies >5 ½ lbs >Medical home

>Full-term babies >ATOD

>Breastfeeding > Immunizations

>I.D. & refer for depression

>self sufficiency

>Reduce infant death rate


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Care Team

Registered

Nurse

Social

Worker

Community

Advocate

Registered

Dietician

Program

Coordinator


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The Service Process

Referral

Enrollment

Interview

Assessment

Care Meetings

(Case Conferences)

Risk Assessment

Scale

Goal & Service

Plan

Quarterly

Review

Home Visits

Support

Referrals



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Our Goals for the Process

  • Bring all partners “together”

  • Maintain ONE care plan

  • Stratify levels of care

  • Guide/organize work through the “chaos” of clients’ lives

  • More accurately reflect level of staff work & client progress (difficult to quantify)


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Healthy Start Program Participants2001-2006

  • 1,008 Pregnant women

  • 639 Infants less than 1 year of age

  • 270 Children 1-2 years of age

  • 772 Births



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Successes

  • Service Plans closed out at discharge

  • Improved documentation

  • Focus on identified issues

  • Consensus among Care Team members on discharge

  • Care Team members learn from one another

  • Compare/contrast individual staff assessments

  • Address issues with expertise from multiple disciplines


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% Low Birth Weight* Among African AmericansCity of Flint and Healthy Start, 2001-2006*

*Low Birth Weight is between 1500 and 2499 grams; 2006 HS data is provisional

Source City of Flint data: Michigan Department of Community Health, Vital Statistics


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% Very Low Birth Weight* Among African AmericansCity of Flint and Healthy Start, 2001-2006*

*Very Low Birth Weight is less than 1500 grams; 2006 HS data is provisional

Source City of Flint data: Michigan Department of Community Health, Vital Statistics


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Infant Mortality Among African AmericansCity of Flint and Healthy Start, 2001-05


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Factors Affecting Outcomes

  • Higher risk moms  more issues, harder to impact/affect change…

  • Entry into program  late trimester = no impact on current pg (but still count stats)

  • Entry into PNC  higher risk moms, harder to reach… how can we improve entry if can’t find them?

  • Documentation


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Marcia Franks

Maternal/Infant Health & Mortality Programs

Genesee County Health Department

630 S. Saginaw Street

Flint, Michigan 48502

(810) 257-3202

[email protected]

Questions?


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